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Root replacement for all allograft aortic valves: preferred technique or too radical?
M F O'Brien1, R S Finney, E G Stafford
1Department of Cardiac Surgery, Prince Charles Hospital, Brisbane, Australia.
Insights
Cryopreserved allografts for aortic root replacement show superior initial valve function. Long-term survival and morbidity are comparable to other techniques, necessitating further follow-up.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Transplantation Immunology
Background:
- Aortic root replacement is a complex procedure.
- Cryopreserved allografts are utilized for aortic root reconstruction.
- Long-term outcomes of aortic root replacement with allografts require evaluation.
Purpose of the Study:
- To assess the long-term outcomes of aortic root replacement using cryopreserved allografts.
- To compare the results of aortic root replacement with non-root allograft implantation techniques.
- To evaluate the safety and efficacy of cryopreserved allografts in aortic surgery.
Main Methods:
- Retrospective analysis of 146 patients undergoing aortic root replacement with cryopreserved allografts from November 1985 to January 1994.
- Complete follow-up to March 1st, 1994, including all recorded events.
- Actuarial survival analysis and assessment of morbidity events such as endocarditis, thromboembolism, structural deterioration, and reoperation.
Main Results:
- Operative mortality was 1.7%, with an 8-year actuarial survival of 85% +/- 8%.
- Low incidence of endocarditis (2 events) and thromboembolism (4 events).
- Low morbidity with 3 events of structural deterioration and 9 reoperations for all causes.
Conclusions:
- Aortic root replacement with cryopreserved allografts demonstrates superior immediate valve function.
- At 8 years, no statistical difference in outcomes was observed compared to non-root procedures.
- Longer follow-up is necessary to definitively determine the preferred technique for aortic root replacement.
Abstract:
From November 1985 to January 1994, 146 patients have received a viable cryopreserved allograft for aortic root replacement. The follow-up was complete, with all events included to March 1st, 1994. The median age of patients was 49 years; 83.6% were male. Valve dysfunction (91 patients), primary aortic wall disease (45 patients), and a combination of both (10 patients) were the indications for aortic root replacement. The current operative mortality is 1.7% (three deaths in 172 patients to July 1st, 1994). Four late deaths have occurred, with an 8-year actuarial survival of 85% +/- 8% (95% confidence limits). Endocarditis (two events) and thromboembolism (four events) had a low incidence. Structural deterioration (three events) and reoperation for all causes (nine events) have constituted low morbidity and are compared with the results after non-root allograft implantation techniques. The clinical and echocardiographic evidence indicates that the immediate results of valve function with root replacement are superior. But no statistical difference between aortic root replacement and non-root procedures is apparent at 8 years, indicating that a longer follow-up is required before the answer to the question "preferred technique or too radical" can be answered.